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. 2019 May 30;68(12):2018-2025.
doi: 10.1093/cid/ciy819.

Measles Outbreak at a Privately Operated Detention Facility: Arizona, 2016

Heather Venkat  1   2   3 , Graham Briggs  4 , Shane Brady  2 , Ken Komatsu  2 , Clancey Hill  4 , Jessica Leung  5 , Manisha Patel  5 , Eugene Livar  2 , Chia-Ping Su  1   6 , Ahmed Kassem  1   7 , Sun B Sowers  5 , Sara Mercader  5 , Paul A Rota  5 , Diana Elson  8 , Evan Timme  4 , Susan Robinson  2 , Kathryn Fitzpatrick  9 , Jabette Franco  4 , Carole Hickman  5 , Paul A Gastañaduy  5
Affiliations

Measles Outbreak at a Privately Operated Detention Facility: Arizona, 2016

Heather Venkat et al. Clin Infect Dis. .

Abstract

Background: We describe a measles outbreak and control measures implemented at a privately operated detention facility housing US Immigration and Customs Enforcement detainees in 2016.

Methods: Case-patients reported fever and rash and were either laboratory-confirmed or had an epidemiological link to a laboratory-confirmed case-patient. Immunoglobulin G (IgG) avidity and plaque reduction neutralization tests distinguished between primary acute and reinfection case-patients. Measles-specific IgG was measured to assess detainee immunity levels. We compared attack rates (ARs) among detainees and staff, between IgG-negative and IgG-positive detainees, and by detainee housing units and sexes.

Results: We identified 32 measles case-patients (23 detainees, 9 staff); rash onsets were during 6 May-26 June 2016. High IgG avidity and neutralizing-antibody titers >40000 to measles (indicating reinfection) were identified in 18 (95%) and 15 (84%) of 19 tested case-patients, respectively. Among 205 unit A detainees tested for presumptive immunity, 186 (91%) had detectable IgG. Overall, the AR was 1.65%. ARs were significantly higher among detainees in unit A (7.05%) compared with units B-F (0.59%), and among male (2.33%) compared with female detainees (0.38%); however, ARs were not significantly different between detainees and staff or between IgG-negative and IgG-positive detainees. Control measures included the vaccination of 1424 of 1425 detainees and 190 of 510 staff, immunity verification for 445 staff, case-patient isolation, and quarantine of affected units.

Conclusions: Although ARs were low, measles outbreaks can occur in intense-exposure settings, despite a high population immunity, underscoring the importance of high vaccination coverage and containment in limiting measles transmission.

Keywords: detainee; measles; outbreak; reinfection; secondary vaccine failure.

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Conflict of interest statement

Potential conflicts of interest. All authors: No reported conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
Simplified schematic of the privately operated detention facility, with housing unit and pod locations and the location of case-patient detainees with measles (n = 23). Additional features of the facility, including locations of the library, commissary, chapel, intake, visitation, court, and recreation yard, are not physically depicted.
Figure 2.
Figure 2.
Confirmed case patients of measles (n = 32) by date of rash onset in a privately operated detention facility in Arizona in 2016.
See this image and copyright information in PMC

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